This chapter provides an analysis of the state of critical care provision in Ireland and of how the withdrawal or withholding of therapies usually happens. It argues that the withdrawal of life-sustaining therapies is not simply a medical matter, but one with considerable social and political dimensions. It identifies the need for public discourse on the subject and for the development of a public policy on critical care. It argues that the answers to the dilemmas that critical care raise cannot most effectively be attained through the courts, but rather the solution is to be found in a social contract on the use of expensive and resource intensive medical technology.